DOCSLIB.ORG

Screening for Lung Cancer: Systematic Review and Meta-Analyses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Screening for Lung Cancer: Systematic Review and Meta-Analyses Screening for Lung Cancer: Systematic Review and Meta-analyses Final Submission: March 31, 2015 McMaster Evidence Review and Synthesis Centre Team: Leslea Peirson, Muhammad Usman Ali, Rachel Warren, Meghan Kenny Maureen Rice, Donna Fitzpatrick-Lewis, Diana Sherifali, Parminder Raina McMaster University, Hamilton Ontario Canada Evidence Review Clinical Expert: Dr. John Miller Canadian Task Force on Preventive Health Care Working Group: Gabriela Lewin (Chair), Maria Bacchus, Neil Bell, Jim Dickinson, Harminder Singh Public Health Agency of Canada Scientific Research Managers: Lesley Dunfield and Alejandra Jaramillo Garcia 1 Abstract Background: This report was produced for the Canadian Task Force on Preventive Health Care (CTFPHC) to inform the development of guidelines on the screening of adults for lung cancer. The last CTFPHC guideline on this topic was published in 2003. Purpose: To synthesize evidence on the benefits and harms of screening asymptomatic adults who are at average and high risk for lung cancer. Data Sources: For benefits of screening we searched CENTRAL, Ovid MEDLINE(R) In- Process & Other Non-Indexed Citations and Ovid MEDLINE(R), and Embase from May 2012 to May 13, 2014 to update the search conducted for the Cochrane 2013 review on this same topic. The same databases were searched to look at harms of screening but the date range was extended to 2000. We also searched for evidence to answer the contextual questions (Embase and MEDLINE; 2009-June 2014), checked reference lists of included studies and relevant systematic reviews, and conducted a targeted grey literature search. Study Selection: The titles and abstracts of papers considered for the key questions and sub- questions were reviewed in duplicate; any article marked for inclusion by either team member went on to full text screening. Full text screening was done independently by two people with consensus required for inclusion or exclusion. For benefits we included randomized controlled trials (RCTs) of screening interventions using chest x-ray (CXR), sputum cytology (SC) and/or low-dose computed tomography (LDCT) in adult populations that reported lung cancer mortality, all-cause mortality, smoking cessation rates, stage at diagnosis or incidental findings. All studies reporting harms of screening or invasive follow-up testing (i.e., overdiagnosis; death, major complications or morbidity from invasive follow-up testing; false positives and consequences of false positives; negative consequences of incidental findings; anxiety; quality of life; infection or bleeding from invasive follow-up testing) were included, regardless of design. Data Abstraction: Review team members extracted data about the population, study design, intervention, analysis and results for outcomes of interest. One team member completed full abstraction, followed by a second team member who verified all extracted data and ratings. We assessed study quality using Cochrane’s Risk of Bias tool (RCTs) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. For the contextual questions, inclusion screening and abstraction were done by one person. Analysis: Risk ratios (RRs) and 95% confidence intervals (CIs) for binary outcomes of benefits of lung cancer screening were calculated using random-effects models. Binary outcomes of harms of screening were reported using proportion per 1,000. Continuous outcomes of harms of screening (e.g., anxiety and quality of life) were reported as mean difference or mean change scores with 95% CIs. Test properties were reported descriptively using means or medians with ranges. GRADE tables were prepared for critical benefits (lung cancer and all-cause mortality) and critical harms (overdiagnosis, death or major complications/morbidity resulting from 2 invasive follow-up testing). For all other outcomes and subgroups, available data were meta- analyzed when appropriate or presented narratively. Results: Thirty-three studies formed the evidence base for this review; 13 RCTs were used to answer the question regarding the benefits of screening for lung cancer and 30 studies provided data to answer the question about harms of screening or invasive follow-up testing. For the critical outcomes of lung cancer mortality and all-cause mortality, the low GRADE quality evidence indicated there is no benefit of CXR screening, with or without SC, when compared to no screening or less intensive screening. Pooled analyses of preliminary results from three relatively small trials comparing LDCT to usual care in high risk adults found no significant benefits for mortality with five years or less follow-up. One high quality trial with a large sample of high risk adults (NLST) and a median follow-up of 6.5 years found screening with LDCT showed significant benefits for mortality when compared with screening with CXR [lung cancer mortality RR 0.80 (95% CI 0.70, 0.92), NNS 308 (95% CI 201, 787); all-cause mortality RR 0.94 (95% CI 0.88, 1.00), NNS 219 (95% CI 115, 5,556)]. Two studies that examined subgroups of interest (age, gender, smoking history) found no differences in lung cancer mortality between the CXR screened and unscreened participants. For the important outcome of stage at diagnosis, most screening strategies for lung cancer showed statistically significant benefits in terms of disease detection. For CXR and LDCT screening, more cases of early stage non-small cell lung cancer and fewer cases of late stage malignancy were observed in the screened and more intensively screened groups compared to the control groups; with the exception of early stage disease detection using dual testing with CXR and SC compared to less intensive screening. In one large trial (NSLT), LDCT demonstrated better efficacy than CXR, detecting significantly more cases of early stage disease (57.0% versus 39.1%) and significantly fewer cases of late stage disease (43.0% versus 60.9%). Though a limited pool of evidence was available, none of the studies that reported on smoking cessation rates found a difference between screened and control groups. Lung cancer screening tests detect a variety of other clinically significant abnormalities, however little and inconsistent evidence was found regarding incidental findings of lung cancer screening. The evidence for harms was primarily obtained from observational studies resulting in low GRADE quality of evidence. CXR screening was associated with: overdiagnosis ranging from 2.27% to 16.28%; 28.60 deaths (95% CI 16.02, 41.17) and 63.32 patients with major complications (95% CI 42.92, 92.49) per 1,000 patients undergoing invasive follow-up testing; median false positives of 65.0 (range 34.0 to 136.7) per 1,000 adults screened; and 2.30 (95% CI 1.49, 3.11) and 2.73 (95% CI 0.96, 4.51) individuals per 1,000 screened, who had benign conditions were subjected to minor and major invasive procedures, respectively, as part of diagnostic follow-up. LDCT screening was associated with: overdiagnosis ranging from 10.99% to 25.83%; 11.18 deaths (95% CI 5.07, 17.28) and 43.29 patients with major complications (95% CI 32.00, 54.58) per 1,000 patients undergoing invasive follow-up testing; median false positives of 167.1 (range 79.0 to 255.3) per 1,000 participants tested with a baseline or a single LDCT screen and 233.0 (95% CI 6.4, 690.0) per 1,000 screened with multiple rounds of testing; and 7.16 (95% CI 3 3.27, 11.05) and 4.98 (95% CI 3.68, 6.29) individuals per 1,000 screened, who had benign conditions were subjected to minor and major invasive procedures, respectively, as part of diagnostic follow-up. Little and inconsistent evidence was available regarding the other critical and important harms of interest (anxiety, quality of life, infection and bleeding from invasive follow-up testing). Recent evidence was located to address a number of contextual questions. LDCT test properties varied across studies depending on the type of reference standard applied, cut-off or threshold value for a positive test, and LDCT technology and technique used. Sensitivity ranged from 80% to 100% and specificity ranged from 28% to 100%. No evidence was found that directly compared LDCT technologies or protocols used by radiologists and their effect on test performance. Diagnostic test properties were highest overall with a multi slice detector, computer assisted reading/diagnosis, and two independent radiologist readers. High risk adults indicated high willingness to be screened for lung cancer, reported neutral or positive screening experiences, and identified some individual and health care system barriers to screening. Variations in burden of lung cancer among Canadian rural, remote, Aboriginal and other ethnic populations are largely a reflection of tobacco use rates among those groups. There is no recent evidence on differential performance of lung cancer screening tests by these subpopulations. Modelling studies suggest annual LDCT screening is the most effective strategy, increasing diagnoses of lung cancer at earlier and more treatable stages and reducing rates of overdiagnosis. The absolute costs of lung cancer screening are difficult to estimate because of diversity across health care systems, variety in outcomes, and different assumptions about hypothetical cohorts. Limitations: Although meeting our inclusion criteria, there was substantial variability across studies in terms of sample characteristics, screening tests, outcomes, comparators, length of follow-up, locations and timing. Only a few studies reported on some of the important outcomes and no evidence was found for a couple important harms. Only two papers included analyses to address the question about sub-group differences. Most of the harms data was obtained from observational studies. Publication bias could not be evaluated, given the low number of included studies in meta-analyses. Test properties were only examined for LDCT screening. No lung cancer risk assessment tools were located. Only papers in English or French were considered. Conclusion: Considering mortality outcomes the available evidence indicated there is no benefit of CXR screening, with or without SC, when compared to no screening or less intensive screening in average to high risk adults.
Load more

Recommended publications
  • Lung Cancer Screening
    Care Process Model NOVEMBER 2017 A DECISION GUIDE AND PROCESS FOR Lung Cancer Screening The U.S. Preventative Services Task Force (USPSTF) recommends annual lung cancer screening for adults who have no signs or symptoms of lung cancer but who are at high risk for developing the disease because of age and smoking history. USP Based on this recommendation and studies from the National Institute of Health (NIH) NLST, Intermountain Healthcare established the Lung Cancer Screening Program with the support of the Oncology Clinical Program, the Division of Pulmonology and Critical Care Medicine, and Department of Imaging. This screening program facilitates annual screening (and more frequent diagnostic testing when indicated) for patients who meet criteria for high risk of developing lung cancer. Why Focus ON LUNG CANCER SCREENING? • Lung cancer is common. According to the American Cancer Society (ACS), GOALS nearly 225,000 cases of lung cancer are diagnosed annually. The ACS estimates The goals of the Lung Cancer Screening that over 155,000 people will die from lung cancer in 2017, representing the leading Program are as follows: cause of cancer-related mortality in both men and women.ACS A major barrier to • Identify appropriate patients for screening reducing mortality is early detection. Only 16 % are diagnosed at an early stage. ALA through primary care providers (PCPs) and other clinicians • Most high-risk patients can be identified through a simple history. • Track appropriate patients long term to About 85 % of lung cancer diagnoses are related to or caused by smoking, and the ensure that they receive annual screening and risk increases with smoking duration and frequency.
    [Show full text]
  • Lung Cancer Screening What Is Lung Cancer Screening? Screening Exams Find Disease Before Symptoms Begin
    Lung Cancer Screening What is lung cancer screening? Screening exams find disease before symptoms begin. The goal of screening is to detect disease at its earliest and most treatable stage. In order to be widely accepted and recommended by medical practitioners, a screening program must meet a number of criteria (https://www.radiologyinfo.org/en/info/safety-hiw_05) , including reducing the number of deaths from the given disease. Screening tests may include lab tests that check blood and other fluids, genetic tests that look for inherited genetic markers linked to disease, and imaging exams that produce pictures of the inside of the body. These tests are typically available to the general population. However, an individual's needs for a specific screening test are based on factors such as age, gender, and family history. In lung cancer screening, individuals who have a high risk of developing lung cancer but no signs or symptoms of the disease undergo low-dose computed tomography (LDCT) scanning of the chest. LDCT combines special x-ray equipment with sophisticated computers to produce multiple, cross-sectional images or pictures of the inside of the body. LDCT produces images of sufficient quality to detect many abnormalities while using up to 90 percent less ionizing radiation than a conventional chest CT (https://www.radiologyinfo.org/en/info/chestct) scan. In the past, doctors used chest x-ray (https://www.radiologyinfo.org/en/info/chestrad) and sputum cytology to check for lung cancer. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.
    [Show full text]
  • CT Screening for Lung Cancer in Heavy Smokers Policy Number: PG0049 ADVANTAGE | ELITE | HMO Last Review: 04/01/2021
    CT Screening for Lung Cancer in Heavy Smokers Policy Number: PG0049 ADVANTAGE | ELITE | HMO Last Review: 04/01/2021 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder terms, conditions, exclusions and limitations contract. It does not constitute a contract or guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede this general policy when group supplementary plan document or individual plan decision directs otherwise. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. SCOPE X Professional X Facility DESCRIPTION In the United States, lung cancer is the most commonly occurring noncutaneous cancer in men and a woman combined, and is the leading cause of cancer deaths. The most important risk factor for lung cancer is tobacco use. Other risk factors are small compared with cigarette smoking—these causal factors include exposures to environmental and occupational substances and family history of lung cancer. Currently, most lung cancer is diagnosed clinically when patients present with symptoms such as persistent cough, pain and weight loss; unfortunately, patients with these symptoms usually have advanced lung cancer. Due to the prevalence and the mortality associated with lung cancer, detecting the disease and initiating treatment at an early stage, in particular, for at-risk individuals is important for improving survival.
    [Show full text]
  • Lung Cancer Screening with Sputum Cytologic Examination, Chest Radiography, and Computed Tomography: an Update for the U.S
    Lung Cancer Screening with Sputum Cytologic Examination, Chest Radiography, and Computed Tomography: An Update for the U.S. Preventive Services Task Force Linda L. Humphrey, MD, MPH; Steven Teutsch, MD, MPH; Mark S. Johnson, MD, MPH Screening for lung cancer is not currently increasing in epidemic proportions,3,4 with an recommended by any major medical professional estimated 1 million deaths in the year 2000.5 organization. The U.S. Preventive Services Task Although there are other important risk factors Force (USPSTF) gave lung cancer screening a “D” for lung cancer,3,6–10 cigarette smoking is the major recommendation in both 1985 and 1996, meaning risk factor; approximately 87% of all lung, that there were fair-quality data to recommend bronchial, and tracheal cancer are attributed to against screening for lung cancer1 based largely on 3 smoking.3 Consequently, the most important public negative trials conducted in the United States in the health intervention that could reduce lung cancer 1970s. Since the last Task Force review, several new incidence and deaths is changing smoking habits. studies of lung cancer screening have been reported, Unfortunately, although overall prevalence rates of and greater attention has been directed toward the smoking in the United States have decreased over limitations of existing literature. This review was the past 2 decades, the prevalence of current adult conducted to aid the current USPSTF in updating smokers remains high at 24%.10,11 In the clinical its lung cancer screening recommendation. setting,
    [Show full text]
  • Patient and Physician Guide: National Lung Screening Trial (NLST)
    Patient and Physician Guide: National Lung Screening Trial (NLST) What is the purpose of this guide? To explain the benefits and harms of low-dose computed tomography (CT) screening for lung cancer in people at high risk for the disease. The NLST showed a reduction in deaths from CT screening compared to chest X-ray screening. The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial recently showed that chest X-ray screening (compared to no screening) did NOT reduce the chance of dying from lung cancer. Who participated in the NLST? Current or former cigarette smokers within the past 15 years, 55 to 74 years of age, with at least 30 pack-years of smoking [Pack-years = packs per day x number of years smoking]. Participants must have had no symptoms or signs of lung cancer or other serious medical conditions, and be medically fit for surgery. Study Findings: Low-dose CT versus Chest X-ray screening 53,454 current and former smokers were randomly assigned to be screened once a year for 3 years with low-dose CT or chest X-ray. Here’s what happened after an average of 6.5 years: Low-dose CT Chest X-ray 26,722 people 26,732 people Benefit: How did CT scans help compared to chest X-ray, an ineffective screening test? 3 in 1,000 fewer died from lung cancer 18 in 1,000 versus 21 in 1,000 5 in 1,000 fewer died from all causes 70 in 1,000 versus 75 in 1,000 Harm: What problems did CT scans cause compared to chest X-ray? 223 in 1,000 more had at least one false alarm 365 in 1,000 versus 142 in 1,000 18 in 1,000 more had a false alarm leading to an invasive such as bronchoscopy, biopsy, or surgery procedure, 25 in 1,000 versus 7 in 1,000 2 in 1,000 more had a major complication from 3 in 1,000 versus 1 in 1,000 Invasive procedures “Take home” messages Lung cancer screening with CT scans is the only screening test shown to lower the chance of dying from lung cancer.
    [Show full text]
  • Protecting Yourself from Lung Cancer: No. 1 Cancer Killer
    Protecting Yourself From Lung Cancer: No. 1 Cancer Killer Risks, Screening, and Diagnosis Timothy M. Clark, MD, FCCP Boulder Valley Pulmonology 303-351-5927 Lung Cancer Scope • #1 cause of cancer related deaths in the US • More death from lung cancer than breast, colon and prostate combined • All comers (smokers and nonsmokers) lifetime risk • 1 in 15-17 men and women • Significantly higher in smokers • 2.1 million cases 2018, 1.8 million deaths worldwide • 130,000-160,000 annual US deaths Lung Cancer Scope • Most lung cancers are caught at a later stage • Poor survival associated with late-stage diagnosis Lung Cancer RISK Lung Cancer Risk- top three risks Smoking Smoking Smoking Lung Cancer Risk • 90% of lung cancers, 1st suggested 1912 • 10-30 fold risk compared to non-smokers • Risk correlates with number cigarettes daily, lifetime duration, depth of inhalation, tar and nicotine content, unfiltered Lung Cancer Risk • Reduced within five years of smoking cessation • 80-90% risk reduction with 15-year abstinence • Will not achieve same risk as never-smoker • Cut back >50% will reduce risk by 27% (if >15/day) • Ongoing smoking with treatment increases mortality, recurrence development of second primary Lung Cancer Risk Second hand smoke • Side stream (smoldering) versus mainstream (exhaled) • either is sufficient to raise risk • Far less intense, but often longer duration of exposure • No controversy • US Surgeon General • US National Research Council • International Agency for Research on Cancer (IARC) Lung Cancer Risk Second hand smoke
    [Show full text]
  • WTC Factsheet: Lung Cancer Screening
    Lung Cancer Screening Lung Cancer Screening and the World Trade Center Health Program Is lung cancer screening available through the World When should screening stop? Trade Center (WTC) Health Program? Once started, LDCT should continue annually until you Yes. Annual lung cancer screening is now being offered reach age 80, or you have completely quit smoking for as a medical benefit for eligible WTC Health Program greater than 15 consecutive years, or you develop a health members. Eligibility is based on age and smoking history. problem that significantly limits your ability or willingness to obtain curative treatment, or you voluntarily withdraw What is lung cancer screening? from the program. Lung cancer screening looks for signs of lung cancer before you feel symptoms from the disease. Low-dose What are the risks and benefits of lung computed tomography (also called a low-dose CT scan cancer screening? or LDCT) is the test now recommended to screen for lung You should talk to your doctor to determine if the cancer. A CT machine scans the body and uses low-dose benefits of this test outweigh the risks for your specific radiation to make a series of detailed pictures of the lungs. medical situation. Screening allows for earlier diagnosis and treatment, One risk associated with LDCT scans is false-positive which may slow or even stop the cancer from progressing. results. This occurs when an LDCT scan suggests lung Many lung cancer deaths can be prevented by screening cancer when, in fact, no cancer is present. False-positive high-risk people every year.
    [Show full text]
  • Lung Cancer Screening 1000 People at Risk for Lung Cancer Ung Cancer Is the International Leading Cause of Cancer Deaths
    JAMA PATIENT PAGE The Journal of the American Medical Association LUNG CANCER = approximately 5 people Lung Cancer Screening 1000 People at risk for lung cancer ung cancer is the international leading cause of cancer deaths. Tobacco use is the principal risk factor for lung cancer and accounts for at least 85% of all Llung cancers. Until recently, no screening test had been shown to be effective in reducing deaths associated with this disease. SCREENING TESTS FOR LUNG CANCER Screening tests detect cancer before symptoms develop, with the goal of decreasing the risk of dying of cancer. Detecting cancers earlier may provide a better chance of a cure. Low-dose computed tomography (CT) scans of the chest are used for lung cancer screening. Low-dose means that lower radiation doses are used compared with a regular diagnostic CT scan. Low-dose CT screening DOES SCREENING FOR LUNG CANCER WORK? 609 had negative • A large study of patients at high risk of lung cancer (the National Lung Screening screening test results Trial [NLST]) showed that CT screening reduced lung cancer deaths by 20% (1.33% in those screened compared with 1.67% in those not screened). • People at high risk of lung cancer are aged 55 years to 74 years, have at least a 30-pack-year smoking history, and are currently smokers or have quit within the 391 had positive past 15 years. screening test results • In the NLST, CT screening had a high false-positive rate and used ionizing radiation. A false-positive result means that a positive screening result is later found to not represent lung cancer.
    [Show full text]
  • CT Lung Cancer Screening Part 1
    CT Lung Cancer Screening Part 1 Session Moderator: Randell Kruger, PhD, DABR Medical Physics Section Head, Radiology, Marshfield Clinic Health System, Marshfield, Wisconsin Session Program: Imaging Education CT Lung Cancer Screening Part 1 First Presentation: – CT Lung Cancer Screening and the Medical Physicist: Background, Findings and Participant Dosimetry Summary of the National Lung Screening Trial (NLST) –Presenter: Randell Kruger, PhD, Marshfield Clinic, Marshfield, WI Second Presentation: – CT Lung Cancer Screening and the Medical Physicist: A Dosimetry Summary of CT Participants in the National Lung Screening Trial (NLST) –Presenter: Choonsik Lee, PhD, National Cancer Institute, Bethesda, MD 2 1 CT Lung Cancer Screening Part 1 Learning Objectives – Review and summarize relevant NLST findings and conclusions – Understand the scope and scale of the NLST specific to participant dosimetry – Provide a comprehensive review of NLST participant dosimetry assessments – Summarize the results of an investigation providing individualized organ dose estimates for NLST participant cohorts 3 CT Lung Cancer Screening and the Medical Physicist: Background, Findings and Participant Dosimetry Summary of the National Lung Screening Trial (NLST) Randell Kruger, PhD, Marshfield Clinic, Marshfield, WI - Ministry Saint Joseph’s Hospital is a 504-bed tertiary care teaching institution and the second largest hospital in the state 2 Introduction and Background Lung Cancer Statistics (American Cancer Society, ACS)1 – Estimated 1.1 billion active smokers
    [Show full text]
  • Is Lung Cancer Screening Right For
    Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current. Is Lung Cancer Screening Right for Me? A decision aid for people considering lung cancer screening with low-dose computed tomography If you have smoked for many years, you may want to think about screening (testing) for lung cancer with low-dose computed tomography (LDCT). Before deciding, you should think about the What are the facts about lung cancer? possible benefits and harms of lung cancer screening. This decision » Lung cancer is the leading cause of aid will help prepare you to talk with your health care professional cancer death in the United States. Each about whether lung cancer screening is right for you. year, about 220,000 people are diagnosed with lung cancer and 150,000 people die What is lung cancer? from lung cancer. Lung cancer happens when abnormal cells form in the lungs and grow out of » About half of the people diagnosed with lung cancer are 70 years of age or control. These cells can form a tumor and can spread to other parts of the body. older. The typical age of death from lung Lung cancer is often diagnosed once it has spread outside the lungs. About cancer is 72 years. 9 out of every 10 people with lung cancer die from the disease because it is found after it has spread. Who should be screened for lung cancer? Possible signs and symptoms of lung cancer The United States Preventive Services Task Force (USPSTF) is made up of experts in » A new cough that does not go away or Many patients with lung cancer do not preventive medicine.
    [Show full text]
  • Screening for Lung Cancer Using Computed Tomography Scanning Or Chest Radiographs
    Medical Policy Joint Medical Policies are a source for BCBSM and BCN medical policy information only. These documents are not to be used to determine benefits or reimbursement. Please reference the appropriate certificate or contract for benefit information. This policy may be updated and is therefore subject to change. *Current Policy Effective Date: 7/1/21 (See policy history boxes for previous effective dates) Title: Screening for Lung Cancer Using Computed Tomography Scanning or Chest Radiographs Description/Background There is interest in screening and early identification of lung cancer because the disease, when identified clinically, tends to have a poor prognosis. Two proposed screening methods are chest radiographs and low-dose computed tomography (CT) scans. These techniques can be used with or without computer-assisted detection (CAD). Due to biases inherent in screening studies, randomized trials that evaluate reduction in lung cancer morbidity and mortality are required to demonstrate the efficacy of screening. Given the poor prognosis of lung cancer, there has been longstanding research interest in developing screening techniques for those at high risk. Previous studies of serial sputum samples or chest x-rays failed to demonstrate that screening improved health outcomes. More recently, there has been interest in low-dose computed tomography (CT) scanning as a screening technique, using either spiral (also referred to as helical) or electron beam (also referred to as ultrafast) CT scanning. Compared to conventional CT scans, these scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete CT scan can be obtained within 20 seconds, or during one breath hold, in the majority of patients.
    [Show full text]
  • Lung Cancer Screening Algorithm
    Lung Cancer Screening Page 1 of 4 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. Note: Screening is only intended for asymptomatic individuals1,2 and should take place in the context of appropriate shared decision making 3. Individuals undergoing lung cancer screening should have a 10-year life expectancy and no co-morbidities that would limit the diagnostic evaluation or treatment of any identified problem. The screening technique should be performed with a consistent technique and process. PRESENTATION RISK SCREENING Proceed to diagnostic evaluation Yes Presence of lung cancer Low Risk: ● Screening not recommended 4 ● If patient is a current tobacco smoker or a recent tobacco smoker who symptoms ? ● Age less than 50 years old and/or has quit within the past year, provide tobacco smoking cessation ● Less than 20 pack-year tobacco smoking history No counseling and refer to the Tobacco Cessation - Adult algorithm High Risk: 5,6 ● Age 50-80 years old and ● Annual low-dose CT lung screening ● Greater than or equal to 20 pack-year ● If patient is a current tobacco smoker or a recent tobacco smoker
    [Show full text]